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General NPI Number Information
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NPI Number | 1326398876
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Entity Type | Individual
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Provider Name | EMILY SHIELDS UPPAL LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 154 MAVERICK ST RM 207
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City | BOSTON
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State | MA
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Zip | 02128-2367
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Country | US
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Telephone | 919-271-8568
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SUMNER ST UNIT 21
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City | BOSTON
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State | MA
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Zip | 02128-2318
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Country | US
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Telephone | 919-271-8568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 118470
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License Number State | MA
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